Samuel Walker saw combat in Iraq firsthand: He was splattered with human flesh and shrapnel in a dining hall when a suicide bomber blew himself up just a few feet away.
When Walker got back to the U.S., he brought some of the battlefield home with him. He heard phantom screams in broad daylight, smelled gunpowder that wasn't there. A loud noise would send him into a defensive crouch. He'd been eating French fries in the mess hall at the time of the blast, and the sight of a McDonald's restaurant now brought back violent memories.
Two doctors diagnosed Walker with post-traumatic stress disorder, or PTSD, directly related to his close encounters with violence in Iraq.
But Walker was not a combat soldier. He was a civilian recreation supervisor for KBR, the largest contractor in Iraq. And instead of getting the medical and counseling help he sought, Walker, a U.S. Army veteran, found himself caught in a morass of red tape and rejected insurance claims.
A Times investigation of a taxpayer-financed insurance system, based on reviews of scores of cases, has found a pattern of repeatedly blocked claims for treatment of psychological injuries sustained by civilian workers in Iraq and Afghanistan.
Some seriously afflicted contract workers have been dumped into indigent medical care programs, according to court records. Many have had to wage lengthy legal battles to win payments for psychological treatment. At least four have committed suicide after returning home from Iraq, according to court records and interviews with attorneys and family members.
Although insurance companies have paid for counseling for many workers, they also have fought claims for psychological treatment more than for other types of injuries, according to data compiled by The Times from Department of Labor records.
Though contractors claiming psychological problems made up about 4% of nearly 1,400 serious reported injuries from 2003 to 2005, such workers accounted for 13% of the cases fought out in courtrooms.
In fighting claims, the insurance companies have relied on doctors with questionable expertise, according to court records and claimants' attorneys.
In one case, an insurance company psychiatrist who specialized in pharmacological research broadly dismissed psychology as "baloney." In another, a psychologist hired by insurance giant American International Group, or AIG, for his supposed expertise in PTSD had seen only 10 to 15 cases in a decade of practice.
The companies have disputed some cases in which their own doctors determined that workers were suffering psychological damage, court records show.
Gary Pitts, a Houston attorney who has represented more than two dozen contractors with psychological problems, said contractors "put their lives on the line, and then they have to wait to get benefits" while insurance companies fight their claims.
The system "is costly; it's inefficient; and it's inhumane," he said.
Insurance companies defended their handling of psychological claims, saying that such cases required more time to diagnose and more documentation to process. They denied any financial motivation in delaying payments.
AIG has the largest number of claims from Iraq. The company said it paid more than half of the claims for psychological injuries, compared with more than 90% of claims for all injuries.
The firm declined to comment on individual cases but said it hired only qualified experts to assess its claims.
"Companies benefit, both from a financial perspective and a customer satisfaction perspective, to settle claims as quickly as possible," said Chris Winans, an AIG spokesman. "We are in the business of paying claims and in the business of making people's lives whole again."
AIG fought Walker's claim for nearly a year and a half, despite a finding by one of its own experts that Walker needed psychological treatment -- until July 2006, when a judge finally ruled in Walker's favor.
Walker said that he understood that working in Iraq could be risky, but that he never expected his toughest battles to take place after he returned home.
Insurance company officials "were fighting because they didn't want to pay," said Walker, 46, a Georgia resident. "Whatever they could do to keep it going as long as possible, they did. They were hoping that I would give up and let it go."
Sharing the battlefield
Walker's is one of scores of cases trickling through an outdated workers' compensation system designed to provide insurance for contractors working overseas.
Originally designed in the 1940s for contractors erecting bases in the South Pacific during World War II, the Defense Base Act was supposed to provide medical care for typical workplace injuries.
The act required contractors to purchase insurance for workers. Because the premiums were included in the price of the contracts, U.S. taxpayers paid them.
In Iraq and Afghanistan, however, ordinary civilians share the battlefield with professional soldiers. Truck drivers are routinely struck by roadside bombs. Private security contractors engage in firefights with insurgents.
As a result, contractors deployed to these war zones often experience the same kind of trauma that produces psychological problems in soldiers. Military surveys estimate that 15% to 20% of soldiers in Iraq show signs of post-traumatic stress disorder, a debilitating condition often attributed to witnessing or participating in violence.
Andries Snyman, 41, was a security guard for Hart Security, a British firm working for a U.S. company, when his convoy was ambushed in May 2005 in western Iraq.
In the 20-minute barrage that followed, all 13 of Snyman's fellow contractors were killed. With his ammunition down to five bullets, Snyman survived by dodging gunfire and hijacking a passing pickup truck. He was wounded by shrapnel in his left leg.
After returning home to South Africa, where he had worked as a policeman, Snyman was afflicted by nightmares. He avoided people who looked like Arabs. He suffered flashbacks of the ambush.
Despite a diagnosis by a psychiatrist in South Africa that he suffered from PTSD, Snyman has been denied payments for medical care or disability.
When Snyman flew from South Africa to Houston for a court hearing on his claim, AIG produced no medical witnesses to contradict his diagnosis, court records show.
"Nobody is looking out for me," said Snyman, who has been unable to resume work as a police officer. He now hauls rubble from construction sites and has had to sell his house to make money for his wife and young child. "I'm desperate to support my family," he said.
Steven Birnbaum, a San Rafael lawyer who specializes in Defense Base Act cases, believes many psychological problems go unreported. Unlike the Department of Defense, which keeps track of post-traumatic stress in soldiers, no government agency monitors the mental health of contractors.
"Contractors have no support. They don't have the VA [Veterans Affairs]. They don't have the Veterans of Foreign Wars, the American Legion, Disabled American Veterans," Birnbaum said.
"We're only seeing the tip of the iceberg. We're at the beginning of a deluge," he said.
For some contractors, psychological help did not come soon enough. One California woman said her husband committed suicide three weeks after returning from Iraq. His is one of four contractor suicides mentioned in court records or interviews with attorneys and contractor advocates.
His behavior had grown increasingly strange in the months before his return, the widow recalled, blaming the intense stress of his work in a war zone.
"He said, 'This is our opportunity. I can start a college fund for our daughter, we can pay off the mortgage and we can have a nice retirement,' " said the woman, who did not want her name used because her claim against the company had not been resolved. "The price has been so high."
In another case, a KBR truck driver who had endured constant attacks during convoy runs returned home to panic attacks and nightmares -- sometimes reliving the desperate moment when he was forced to use a claw hammer in hand-to-hand combat to defend his truck against an insurgent. Robert Purcella's severe anxieties left him unable to work.
KBR paid for eight counseling sessions, but insurance carrier AIG refused further treatment, according to court records. Purcella lived in a garage and was seeking help at a county mental health clinic for the indigent when a court ruled in his favor against the company.
Purcella could not be reached for comment.
The arcane procedures of the workers' compensation system make it easy for insurance companies to contest claims for psychological stress, even when multiple doctors have diagnosed PTSD.
A long-haul trucker, Steve Thompson went to work for KBR in Kuwait in May 2004, but soon ended up driving in Iraq. He repeatedly encountered small-arms fire, several times with rounds penetrating his truck. On one occasion, a roadside bomb cracked his windshield.
Thompson was never physically hurt, but he began to dread the missions and the constant risk of death. "It was like a lottery that you didn't want to win," Thompson said.
The final straw came in November 2004, when Thompson was sent to help clean up the remains of an ambush. He smelled burned flesh the moment he climbed from his truck.
"I couldn't do it anymore. I had enough," Thompson said.
A month later, Thompson was back in North Carolina, with no job, but with monthly child support to pay.
He couldn't bring himself to get behind the wheel anymore. Thompson took several menial jobs in construction, but he quarreled constantly with bosses and drifted for more than a year.
Two psychologists diagnosed him with post-traumatic stress disorder. As a veteran, Thompson was able to see doctors at the local VA hospital, who also diagnosed him as suffering from PTSD.
But a doctor hired by AIG found otherwise. At a hearing in February, the doctor, John Griffith, said one diagnostic exam showed that Thompson was exaggerating his symptoms. He said Thompson did not suffer from PTSD.
Griffith said he had treated more than 100 PTSD patients but acknowledged in testimony that he had spent much of his career in pharmacological research. He also told the hearing that "a lot" of psychology was "baloney."
"I'm sure that anyone who served in Iraq, whether they're shot at or not, finds the experience unpleasant to some degree," he said.
No ruling has been issued in the case. In the meantime, Thompson continues to suffer nightmares and fits of anger.
"I'm just trying to get more normalcy in my life," he said. "I don't know what else to do."